A National Imperative: Oral Health Services In Medicare

Dental benefits are not included in Medicare despite the reality that more Americans are living well beyond their 65th birthdays. In the United States, 10,000 people turn 65 every day, which drives the increasing cohort of seniors. Today, the number of seniors—47 million—essentially will double by 2050 according to demographers, and there is no doubt that oral health and general well-being are inextricably bound together. Many conditions that plague the body are manifested in the mouth, a readily accessible vantage point from which to view the onset, progression, and management of numerous systemic diseases. Periodontal diseases are generated by microorganisms that readily can enter the general circulation and cause bacteremia, resulting in adverse systemic effects that can promote conditions such as atherosclerosis. Study investigators assert that adverse cardiovascular effects from periodontal diseases are due to a few high-risk oral microorganisms associated with the pathogenesis of atherosclerosis via increased lipoprotein concentrations, endothelial permeability, and binding of lipoproteins in the arterial intima. In this guest editorial we assert that oral bacteria influence the pathogenesis of atherosclerosis and a number of other chronic degenerative diseases. We argue that sufficient scientific and health economic evidence support providing oral health benefits to older adults through the Medicare mechanism.